Stanford Health Policy’s Paul Wise just returned from Poland where he was helping coordinate the evacuation of child cancer patients from Ukraine in an effort to get them to appropriate medical care facilities in European countries, Canada, and the United States.
Wise, the Richard E. Behrman Professor of Child Health and Society and a Senior Fellow at the Freeman Spogli Institute for International Studies, was serving as a senior advisor to the evacuation program developed by St. Jude Children’s Research Hospital and a consortium of pediatric cancer programs throughout Eurasia. Four weeks into the military invasion by Russian forces, the emergency program has evacuated almost 600 children at various stages of cancer treatment and is transporting them to some 200 hospitals in 28 countries.
Wise was asked to join the emergency effort by Asya Agulnik, a pediatric intensivist and graduate of the Stanford School of Medicine (2010), who is leading the SAFER Ukraine initiative at St. Jude Global, the global health arm of St. Jude.
Agulnik said her ongoing mentorship with Wise has transformed her career as she realizes she can be both a clinician scientist and a global health humanitarian.
"There’s a lot of people who do humanitarian work as a career — which is typically not the traditional work as an academic clinician scientist — but Paul has taught me that this type of work elevates all the partners who are involved. It’s an approach that can help get institutional backing in the middle of a war."
Stanford Health Policy spoke with Wise on Tuesday, the day he flew back from Poland on a U.S. State Department jet carrying four child cancer patients and their families for treatment at St. Jude in Memphis, Tenn. This was the first group of patients to be transferred to the U.S., a transfer conducted in cooperation with the White House, Department of Defense, Homeland Security, and other U.S. government agencies.
Wise is no stranger to conflict, having spent the last 50 years working with children in Guatemala during that country’s brutal decades-long civil war, as well as the civil wars in Yemen and Iraq and central Africa. He is the co-principal investigator of the Children in Crisis Initiative at Stanford, the first university-based program to address the needs of children in areas of unstable governance and civil conflict. In 2019, Wise was appointed a special expert by the U.S. Federal Court overseeing the treatment of migrant children at the U.S.-Mexico border, a role that has required him to provide independent assessments of conditions and procedures in migrant child detention facilities and shelters around the country.
You’ve observed so many children in crisis over the years. What are your initial thoughts after this whirlwind nine-day visit to help coordinate the transportation of these children and their families from the warzone in Ukraine to safe hospitalizations in other countries?
It is profoundly tragic — and I’ve worked in a lot of very complicated security and political environments. The striking thing is how senseless this war is. Of course, all war is catastrophic and terrible, but this sense of betrayal that the people feel is profoundly sad. But at the same time, the striking thing was the strength of the families in a country under siege. These are families not only caught up in a war, but their kids have a really serious disease and have now been forced to evacuate their homes, leave the fathers behind, with their mothers now taking their kids elsewhere as refugees. Some are in the middle of chemotherapy or radiation, and suddenly they’re on their way to a fantastic clinical environment, but also to a new place, totally disorienting. All this — and yet their strength is also something that provides people like me with rewards for working with them. I come away exhausted but also invigorated.
Tell us about your role and the process during those nine days at the Unicorn Marian Wilemski Clinic, a makeshift triage center set up in Bocheniec, Poland, for the children who are examined and then sent on to other countries for cancer treatment.
My role was looking at how the system was functioning and then helping St. Jude’s transform an emergency response to a sustained response, working with the local officials, clinicians and government agencies to assure that transportation and clinical needs and all the immigration and flight requirements are met. This recent transfer of children to the U.S. was the first time a group of children was going to the United States. I was asked to work with all the government agencies to make sure that all went well and the children arrive safely.
The leader of their program is Asya Agulnik, an intensivist (a physician who provides special care for critically ill patients) and St. Jude’s director of their Eurasian region of their global health department. She was a former student of mine, a medical student at Stanford who was in Guatemala with me, and I’ve maintained close contact with her. So when the Ukraine war broke out, their regional program — which was basically a consortium of European and Ukrainian pediatricians, hematology and oncology cancer docs — asked me to help.
The St. Jude SAFER Ukraine initiative is actually quite a remarkable program. Transferring kids with serious illnesses has been done before of course, but this is at scale with bombs falling nearby. The Ukrainian team based in the western city of Lviv refers the patients to the SAFER Ukraine consortium and gets them out of Ukraine, into Poland and then to the St. Jude program triage facility, which then transfers them to the most appropriate facilities in Europe. Ukrainian docs in Lviv, under desperate conditions, evaluate these kids, discuss their clinical problems and organize a convoy on buses to the Polish border. They are met by a medical train set up for special evacuation run by the Polish Ministry of Health. Severely ill children are taken by ambulance or helicopter to Polish hospitals. Most take the train to the station close to the St. Jude triage clinic. There they are registered, assessed and then within 48 hours or so put on planes to Germany, France, Spain, Switzerland, Australia, more than 20 European countries and Canada that have volunteered to take these kids and their families.
You’re a pediatrician and a professor. How does your role as an academic trying to improve policy for children inform your work in crisis environments like this one?
Asya calls me one of her mentors — and if there was ever an illustration of how your teaching can change the world, it’s what has happened in Asya’s leadership of the SAFER Ukraine initiative. Asya and her St. Jude leaders, in particular, Dr. Carlos Rodriguez-Galindo, asked me to help think through the challenges she was facing as she was heading to Poland. After conversations about the particularly challenging elements of how to get the kids transferred safely, it became clear that I should go, with the hope that I could work with the St. Jude team on the ground and provide support in addressing some of the security considerations and coordination requirements with government authorities.
You’ve been working with children in crisis around the world for some 50 years now. How do you maintain your optimism and humanity as violence remains a key characteristic of human evolution?
I came home from my first few years working in Guatemala realizing that justice implies struggle. The challenge is to make some meaningful contribution to this struggle. That contribution doesn’t have to be assessed by some technical evaluation or academic metric. There are many ways people engage with these issues, the struggle for justice if you will. I have always felt that one must respect the heterogeneity inherent in that struggle. Poets struggle, artists struggle, musicians struggle, doctors struggle — there’s no one best way to struggle and there’s always opportunity to contribute. And as a physician there are certain ways our skills provide a basis for contribution. One of course is clinical care. But we also see things that other people don’t see. People share with us part of their world that they won’t share with other people. We have the responsibility of bearing witness, for me through epidemiology and policy evidence, of things that other people don’t see. So, this direct care and this witness narrative — that is what we do at Stanford. That’s part of our academic capability, to bear witness in ways in that others cannot.
Is anyone getting lost in this historic narrative unfolding in Ukraine?
The hero in this whole narrative, in addition to the families themselves, are the doctors in Lviv in Ukraine, who in many ways are risking their lives putting together these convoys of children. They’re not just throwing them on trains and busses, but they’re evaluating them and providing medical records and ensuring high-quality and humane care in the midst of war. We’ve seen that hospitals and schools and theaters are not immune to the destruction, and in fact they can actually be targeted, so the focus and commitment of our medical colleagues in Ukraine, their courage and humanity is just remarkable and for me, even after all these years, deeply inspirational.